What is your hemoglobin target for patients with nondialysis chronic kidney disease who are receiving ESA therapy?

I again shoot for a hemoglobin of 10-11 g/dL. This will help decrease risk of needing transfusion while minimizing risk of elevated blood pressure.

10-11 is my usual target, but sometimes I get pushback from the patient's pharmacy benefit manager when the Hb exceeds 10, since the FDA-approved label says to taper or discontinue ESA in patients with NDD-CKD when the Hb exceeds 10.

I typically aim for 10-11 once initiated on ESA, but there are nuances based on individual patient factors (symptoms, level of activity, risk of adverse events, etc). I usually do not initiate ESA unless patients have symptoms related to anemia or there is a trend suggesting that Hb will fall below ...